<p> Dr. Glen McClung 463 Ohio Pike Cincinnati, OH 45255 513-354-3700 Hip Labral Repair Protocol</p><p>The attached protocol should be used as a guideline for progression of physical therapy for patients after a hip arthroscopy with a labral repair. It may be altered by Dr. McClung based on the surgical procedure and other patient factors. Please contact Dr. McClung or his staff with any questions regarding progression.</p><p> Patient will be seen by Dr. McClung 2-3 days post operatively then referred to physical therapy to start within a couple of days after being seen in the office.</p><p> Patient will be placed in a brace in the operating room prior to discharge and the patient will remain in the brace for 6 weeks post operatively.</p><p> Patient will remain toe touch weightbearing and on crutches for 4 weeks after surgery.</p><p> Hip flexion should be limited to no more than 90 degrees and external rotation and cross body adduction should be avoided to keep stress off the repair site. </p><p>PHASE 1: Weeks 1-3</p><p> Goals: </p><p> o Focus on mobility, especially IR, and isometric strengthening </p><p> o Core strengthening</p><p> o Pain control</p><p> Ankle pumps</p><p> Glute, Quad, and Hamstring sets</p><p> Adductor isometrics</p><p> Heel slides (limit hip flexion to less than 90 degrees)</p><p> Pelvic tilts and bridges with bilateral legs</p><p> Quadruped rocking progress into closed chain cat/camel</p><p> Knee extensions seated with hip at 90 degrees</p><p> Iliopsoas and abdominal stretching prone on elbows Dr. Glen McClung 463 Ohio Pike Cincinnati, OH 45255 513-354-3700  Standing 4-way with no resistance</p><p> o Start resistance low and as tolerated in weeks 2 or 3</p><p> Upright bike with no resistance (limit hip flexion to less than 90 degrees)</p><p> Hamstring, Iliopsoas/ Rectus Femoris stretching within ROM limitations</p><p> Week 3- Start SLR (extension, abduction and adduction)</p><p>May Progress to phase 2 when: (1) Pain free or minimal pain with all of the phase 1 exercises, (2) Hip flexion to 90 is pain free, (3) ROM with IR/extension/abduction has no limitations.</p><p>PHASE 2: Weeks 4-6</p><p> Goals:</p><p> o Progress Core strengthening</p><p> o Continue LE ROM and strengthening</p><p> o Stability and balance progression</p><p> Continue phase one exercises and progress as tolerated by patient</p><p> Crunches</p><p> Add resistance to stationary bike</p><p> Start aquatic therapy as long as incisions have healed</p><p> o Flutter kicks, swimming, 4-way hip with water weights, step ups</p><p> Weight shifts- start with front and side standing and progress to standing, sitting, supported, ant/post and lateral</p><p> Leg press</p><p> Mini squats </p><p> Single leg bridges Dr. Glen McClung 463 Ohio Pike Cincinnati, OH 45255 513-354-3700 Progress to phase 3 when: (1) 105 degrees of flexion, 20 degrees of ER, (2) Hip flexion strength is 60% of contralateral side, (3) Adduction/IR/ER/Extension is 70% of contralateral side.</p><p>PHASE 3: Weeks 7-8</p><p> Goals:</p><p> o Progress ROM and strengthening</p><p> o Advance balance and proprioception</p><p> Progress closed chain exercises and balance training</p><p> Single leg balance</p><p> Clam shells</p><p> Calf raises</p><p> Physioball core strengthening (hip lift, hamstring curls, bridges)</p><p> Wall squats</p><p> Lunges- single plane to triplanar</p><p> Theraband walking (sidestepping, forward, backward, etc.)</p><p> o Progress band from knee height to ankle height</p><p> Single leg squats </p><p> Lateral step ups </p><p> Elliptical trainer </p><p>Progress to phase 4 when: (1) pain free, normal gait, (2) Hip flexion strength 70% of contralateral side, (3) Adduction, extension, IR/ER strength 80% uninvolved side.</p><p>PHASE 4: Weeks 9-12</p><p> Goals: Dr. Glen McClung 463 Ohio Pike Cincinnati, OH 45255 513-354-3700 o Begin agility training and progress cardiovascular training</p><p> o Achieve full ROM (symmetrical flexibility)</p><p> o Progress strengthening </p><p> Pool Running</p><p> Increase resistance on elliptical</p><p> Agility drills</p><p> o Step drills, quick feet step ups, carioca</p><p> Increase distance of theraband walking patterns (50 yds.)</p><p> May golf (chip/putt) at 3-4 months</p><p>Progress to phase 5 when: (1) Pain free phase 4 exercises, (2) strength is symmetrical to contralateral side</p><p>PHASE 5: Weeks 13-16</p><p> Goals:</p><p> o Sport specific training</p><p> o Progress to return to sport</p><p> Advance squat, lung and core stability </p><p> Begin plyometrics (start with double leg an progress to single leg exercises)</p><p> Begin running at 4months- avoid any cutting or pivoting until 5-6 months</p><p> Traditional weight lifting</p><p>Return to Sport Criteria</p><p> Full ROM</p><p> Equal strength bilaterally </p><p> Able to do sport-specific drills without pain at 100%</p><p> Pass functional sports test Dr. Glen McClung 463 Ohio Pike Cincinnati, OH 45255 513-354-3700  Dr. McClung’s discretion</p>